阿莫西林致急性肾功能衰竭

患者女,59岁。因血尿3d,伴腰痛、排尿困难10h,于2002年6月20日入院。两月前无明显诱因出现咳嗽、咳痰、伴胸痛、无畏寒、发热。两月来症状无缓解,3d前来我院就诊,摄胸片示两下肺感染,给予阿莫西林(羟氨苄青霉素)4.0g加入0.9%氯化钠注射液250ml中静滴,阿莫西林(本原莫星分散片)0.5g口服,qd,用药当晚,患者无明显诱因出现血尿,同时伴有尿频、尿急、及尿道烧灼痛,无排尿困难。因怀疑由药物引起,改用喹诺酮类药物抗感染治疗,疼痛缓解,小便转清。第2天,上述症状再次出现,并伴有左侧腰痛,为持续性胀痛,故来院复诊。即行导尿术,导出肉眼血尿40ml左右…     

阿莫西林致急性肾功能衰竭1例

患者，女，60岁，因上呼吸道感染静脉滴注阿莫西林（海南海灵制药有限公司，批号0411011）6．0g加入0．9％氯化钠注射液200mL中，qd。次日继续用药，用药第3天中午出现血尿，排尿时伴有尿道烧灼感、腰痛、疲乏无力，自测体温37．2℃。到急诊科就诊，以“膀胱炎”收入院，急行尿检，尿蛋白（＋＋＋）、尿糖（＋）、红细胞（＋＋＋＋）。遂给予头孢曲松钠继续抗炎（4．0g分两次给药），肾必需氨基酸，250mL，qd，静脉滴注，贝那普利5rng，bid，口服，以保护肾功能。     

阿莫西林致急性肾功能衰竭3例

例1女,64岁。患者于2004年10月2日因咳嗽、咳黏痰,在我院门诊以“肺部感染”治疗。既往无肾病史。给予阿莫西林(羟氨苄青霉素)4.0g加入0.9%氯化钠注射液250m L中静脉滴注,1次/d,4d后,患者咳嗽、咳痰缓解,但出现全程性肉眼血尿,伴尿痛、少尿,每日尿量约330m L,中、下腹部隐痛不适,恶心、呕吐。尿常规示尿蛋白( ),血生化:BUN11.05mmol/L,Cr275μmol/L;肾脏B超提示双肾增大,诊断为急性肾衰、药物性间质性肾炎收入院。入院后停用阿莫西林,经利尿、保护肾功能等积极治疗,患者安全度过少尿期、多尿期,肾功能恢复正常,出院时查血生化示BUN、…     

静脉滴注阿莫西林致急性肾功能衰竭1例

阿莫西林作为广谱青霉素类药,已广泛应用于临床。由于青霉素类药易发生过敏反应,引起间质性肾炎,大剂量应用可引起急性肾功能衰竭,如及时停药,可以得到缓解和恢复。我科于2001年4月收治1例静脉滴注阿莫西林致急性肾功能衰竭患者,现报道如下。 1 病例介绍 患者,女,40岁。因咳嗽、咳痰、咽痛1周,腰痛、肉眼血尿1天、无尿半天于2001年4月3日下午2时收入院。患者入院前因急性上呼吸道感染,给予生理盐水250ml+阿莫西林8g静滴3天后,出现腰痛、血尿呈鲜红色,后无尿。入院查体:体温36℃,心率80次/min,血压21/12kPa。实验室检查:尿素氮9.07mmol/L,肌酐103mmol/L,白细胞16.3×10~9/L,中性粒     

注射用阿莫西林静脉滴注致急性肾功能衰竭1例

患者,女,52岁,2012年7月17日因干咳到当地社区医院就诊,子“阿莫西林针2．0g静滴2次／日”抗感染治疗,次日出现尿量减少,每日少于400mL,伴鲜红色血尿,停用阿莫西林,逐渐出现腹胀、呕心、呕吐,呕吐物为水样物。7月19日转入长沙市中心医院就诊,人院体格检查示体温（T）36．6℃,脉搏（P）80次／分,呼吸（R）20次／分,血压（Br）134／80mmHg,查。肾功能示尿素18．22mmol／L,肌酐358．50μmol／L。     

不规范使用阿莫西林致急性肾功能衰竭可疑病例分析

1病例介绍患者孙某,男,67岁,农民。因车祸致左髋部疼痛、活动受限,于2011年10月22日10时来我院急诊。受伤时神志清楚,无昏迷、恶心、呕吐、胸闷、呼吸困难,感左腿髋部疼痛剧烈,X片示"左股骨粗隆间骨折"。右小腿内侧可见约4 cm左右的     

1例阿米卡星致急性肾功能衰竭患者死亡的原因分析

目的:分析阿米卡星致急性肾功能衰竭患者死亡的原因.方法:1例89岁男性患者,因"间断气短5年,加重伴双下肢浮肿半月"入院,住院期间因肺部感染使用硫酸阿米卡星注射液后尿量逐日减少,肌酐、尿素氮明显升高,被诊断为"急性肾功能衰竭",药品不良反应关联性评价为"很可能".结果:停用硫酸阿米卡星,实施血液透析治疗,其效果甚微,肾...     

甘露醇致急性肾功能衰竭

1 病案摘要 患者男,61y,因突发性昏迷,右侧肢体瘫痪2h入院。28a前曾被诊断为风湿性心脏病,二尖瓣狭窄及闭锁不全,并发房颤。体格检查:体温37.2℃,脉搏98次/min,呼吸24次/min,血压24.4/13.8kPa,深昏迷,双侧瞳孔等大,对光反射迟纯,心律不齐,心前区有三级收缩期吹风样及舒张期隆隆样杂音。腹平软,肋下未触及肝、脾,右侧肢体瘫痪,腱反射消失,巴彬斯基征阳性,右侧肢体肌张力增高。化验检     

利福平致急性肾功能衰竭

口服利福平引起急性间质性肾炎，可导致急性肾功能衰竭。我们将1991年至1996年遇到的7例口服利福平导致急性肾功能衰竭报告如下。7例病例平均年龄为41岁。4例既往曾连续服用利福平，末发现不良反应。7例病人此次发病均在首次间歇服用或停药后重新间歇服用时发生；利福平服用量均为450mg／d，总量平均为1575mg；7例起病均急骤，少尿期平均11．3d，平均血最高尿素氮为40．2mmol／L，平均最高血肌研为1320μmol／L。在采用激素及其它对症治疗的同时5例采用血液透析治疗，2例采用腹膜透析治疗，7例均获痊愈。多数学者认为利福平导致急性肾功能…     

亚砷酸致急性肾功能衰竭

患者男,40岁。因心悸、发热1月,于2003年4月15日入院。查体:BP125/80mmHg(1mmHg=0.133kPa),体重48kg,贫血貌,全身浅表淋巴结未触及肿大,心界不大,HR90次·min-1,肝脾肋下未及。入院后检测血常规:WBC3.79×109·L-1,Hb74g·L-1,PLT54×109·L-1。血涂片检查:N0.28、L0.6、M0.11,红细胞大小不等。骨髓细胞学示:增生活跃,原始粒细胞增多,占9.5%。胸正位相无异常。诊断:骨髓增生异常综合征,难治性贫血,伴原始细胞增多型。经2个疗程柔红霉素+阿糖胞苷(DA)方案化疗,无效。2003年6月27日开始使用亚砷酸10mg,1次/d静滴治疗。用药过程中,患…     

阿莫西林过量致急性肾衰竭

1例44岁拟行子宫肌瘤切除术患者,为预防感染于术前5d开始给予阿莫西林6.0g溶于0.9%氯化钠注射液500mL中静脉滴注,1次/d。术后约15min患者出现血尿,SCr为140.99μmol/L。考虑急性肾衰竭与阿莫西林剂量过大有关。停用阿莫西林,改为头孢噻肟和美洛西林-舒巴坦,同时给予呋塞米、泮托拉唑。术后14d患者肾功能恢复正常。     

Acute renal failure secondary to non-traumatic rhabdomyolysis following amoxapine overdose

A case is reported of amoxapine overdose followed by acute rhabdomyolysis and myoglobinuric acute renal failure. There was disseminated intravascular coagulation and later hypercalcaemia. The patient recovered.     

卡培他滨引起急性肾衰竭

1名94岁男性直肠腺癌患者接受卡培他滨化疗。在第3周期给予卡培他滨1500mg,2次/d,用药12d后,患者出现嗜睡、心慌、发热,血Cr由145μmol/L上升到173μmol/L,BUN由10.9mmol/L上升到27.4mmol/L,立刻停药。6d后,SCr310μmol/L,BUN62.5mmol/L。给予复方α-酮酸、利尿剂、低蛋白饮食等治疗,SCr及BUN逐渐下降。4个月后复查,SCr及BUN恢复正常。     

Acute renal failure

Acute renal failure remains an important clinical problem with little progress made in the therapeutic approach over the past 20-30 years. The purpose of this review is to discuss possible etiologies, their diagnosis, differentiation and possible prevention. The pathophysiology of prerenal azotemia and ischemic acute renal failure are also discussed. The importance of understanding different body volume components, the urine analysis and the FE Na(+) are explained.     

Acute renal failure

Acute renal failure (ARF) is common among critically ill patients and renal dysfunction is often associated with the multisystem organ failure syndrome. The mortality of ARF remains high but animal data indicate that prevention and early treatment may decrease the morbidity and mortality. This review defines ARF based on urine volume, laboratory parameters, and clinical presentation. The pathophysiology of prerenal, postrenal, and intrinsic ART are differentiated and diagnostic criteria provided. Preventive therapy, supportive care, and proposed treatments are outlined. Studies examining the prevention and treatment of ARF in animal models and trials in humans are evaluated. Mannitol 0.5-1 g/kg, furosemide 0.5-1 mg/kg initially, and dopamine 1-5 micrograms/kg/min are effective in preventing or decreasing the severity of ARF in animal models. In humans these drugs are effective at maintaining urine output in various clinical situations and converting oliguria to nonoliguria in some patients; however, increased survival has not been adequately proven as of yet. Dialysis and experimental therapy are briefly discussed.     

Acute renal failure secondary to angiotensin II receptor blockade in a patient with bilateral renal artery stenosis

A 54-year-old man with diabetes mellitus, peripheral vascular disease, and hypertension was admitted to the hospital for an acute exacerbation of chronic heart failure. Therapy with intravenous furosemide and oral losartan 100 mg twice/day was begun. Ten days later, the patient's blood urea nitrogen and serum creatinine levels rose and peaked at 110 and 6.0 mg/dl, respectively. His serum potassium level increased to 5.7 mg/dl, urine output dropped to 400 ml over 24 hours, and mental status changes occurred. Magnetic resonance angiography revealed bilateral renal artery stenosis. After losartan was discontinued and hemodialysis was performed for 3 consecutive days, the patient's renal function returned to his baseline level. Reports in the medical literature reinforce the importance of recognizing that angiotensin-converting enzyme inhibitors should be used with caution in patients with bilateral renal artery stenosis. However, the literature is not as definitive about using of angiotensin II receptor blockers (ARBs) in these patients. Our patient's experience suggests that ARBs should be used with caution in patients with bilateral renal artery stenosis. Clinicians should be aware that renal failure might occur when using ARBs in these patients.     

阿昔洛韦过量致急性肾衰竭

例19岁男性传染性单核细胞增多症患者拟给予阿昔洛韦600 mg加入10%葡萄糖注射液250 ml中静脉滴注.但因用药错误将阿昔洛韦3.0 g加入10%葡萄糖注射液250 ml中静脉滴注.输注完毕后9 h,患者出现明显腰痛,尿量减少,尿蛋白(+ +),尿潜血(+ +).随后出现24 h无尿.第3天肾功能检查:血清肌酐557 μmol/L,尿素9.2 mmol/L.肾脏超声示双肾弥漫性病变.行血液净化,并给予甲泼尼龙40 mg/d静脉滴注,治疗2 d.肾功能逐渐好转,尿量增多.第15天患者肾功能及尿常规检查均无异常,痊愈出院.     

米卡芬净相关急性溶血反应并肾衰竭

1例71岁男性患者因胃溃疡及幽门梗阻行胃次全切除术后出现肠瘘和腹腔真菌感染,给予氟康唑治疗后出现皮肤过敏反应,换用米卡芬净50 mg入0.9%氯化钠注射液100 ml,1次/d静脉滴注。输注约65 ml时,患者突然出现全身发绀、呼吸急促,排棕红色尿。实验室检查示白细胞计数52.5×109/L,红细胞计数2.7×1012/L,血红蛋白78 g/L,血小板计数118×109/L;血清尿素氮21.5 mmol/L,肌酐113μmol/L;尿隐血200 cell/μl,红细胞满视野。立即停止输液,给予血液透析等治疗,情况逐渐好转。2周后血尿常规及肾功能检查基本恢复正常。